| NPI | 1245681147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CA A168931) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.068837) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: CA A168931) | |
| Enumeration Date | 2016-06-22 |
| Last Update Date | 2024-03-08 |