| NPI | 1114259462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: LA 203541) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: LA 203541) |
| 2085N0700X Radiology, Neuroradiology (Licence: LA 203541) | |
| Enumeration Date | 2010-02-10 |
| Last Update Date | 2010-03-16 |