| NPI | 1013264167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MN 55590) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 106252) |
| Enumeration Date | 2012-08-08 |
| Last Update Date | 2013-04-18 |