| NPI | 1134573983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: WA MD61229806) |
| Additional Taxonomies | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: WA MD61229806) |
| Enumeration Date | 2016-04-19 |
| Last Update Date | 2024-08-30 |