| NPI | 1639126196 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MD D84029) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: CT 69290) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: MA 228208) | |
| 2085N0700X Radiology, Neuroradiology (Licence: MA 228208) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 228208) | |
| Enumeration Date | 2006-05-30 |
| Last Update Date | 2021-10-19 |