| NPI | 1568024487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085N0700X Radiology Neuroradiology (Licence: OH 35.153129) |
| Additional Taxonomies | 208600000X Surgery (Licence: ND RL15780) |
| Enumeration Date | 2019-07-01 |
| Last Update Date | 2025-07-07 |