| NPI | 1629456108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085N0700X Radiology, Neuroradiology (Licence: PA MD471816) |
| Additional Taxonomies | 208600000X Surgery (Licence: RI LP03429) |
| Enumeration Date | 2015-05-15 |
| Last Update Date | 2022-01-03 |