| NPI | 1376569517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084V0102X Psychiatry & Neurology, Vascular Neurology (Licence: CA A72443) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: CA A72443) |
| 2085N0700X (Licence: TX FTL 41971) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TX FTL 41971) | |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2012-08-31 |