| NPI | 1982694642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: NY 305839) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: NC 2018-00346) |
| 207T00000X Neurological Surgery (Licence: WI 63470-21) | |
| Enumeration Date | 2005-10-25 |
| Last Update Date | 2020-08-05 |