| NPI | 1265408843 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: NY 220272) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 220272) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NY 220272) | |
| Enumeration Date | 2006-02-24 |
| Last Update Date | 2014-09-25 |