| NPI | 1043579873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: UT 12848372-1205) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: AL 42365) |
| Enumeration Date | 2012-05-14 |
| Last Update Date | 2023-11-14 |