| NPI | 1255367710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TX M0267) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX M0267) |
| Enumeration Date | 2006-06-24 |
| Last Update Date | 2023-04-25 |