| NPI | 1679736938 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: GA 68224) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: DC MD039565) |
| 282N00000X General Acute Care Hospital (Licence: IL 125046943) | |
| 282N00000X General Acute Care Hospital (Licence: VA 0101249516) | |
| 282N00000X General Acute Care Hospital (Licence: DC fk1937359) | |
| 282N00000X General Acute Care Hospital (Licence: MD d0072280) | |
| Enumeration Date | 2008-07-08 |
| Last Update Date | 2019-11-05 |