| NPI | 1912522202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: NY 302918-01) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ME154386) |
| Enumeration Date | 2020-06-11 |
| Last Update Date | 2023-04-04 |