| NPI | 1083932214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: NY 298209) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: FL ME 128064) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME 128064) | |
| Enumeration Date | 2010-05-12 |
| Last Update Date | 2022-10-27 |