| NPI | 1457611873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME144223) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL 144223) |
| 207T00000X Neurological Surgery (Licence: FL 17373) | |
| Enumeration Date | 2012-05-18 |
| Last Update Date | 2021-07-02 |