| NPI | 1679684872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MS 22774) |
| Additional Taxonomies | 174400000X Specialist (Licence: MI 4301077845) |
| 207T00000X Neurological Surgery (Licence: MS 22774) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2014-07-31 |