| NPI | 1649349408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: KY 44369) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: FL TRN8131) |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2016-06-09 |