| NPI | 1679684872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101269688) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: MS 22774) |
| 174400000X Specialist (Licence: MI 4301077845) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2020-02857) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MS 22774) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2026-03-31 |