| NPI | 1720020894 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: WA MD60021578) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: CA AFE92388) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: WI 311) | |
| 2086S0102X Surgery, Surgical Critical Care (Licence: CA AFE92388) | |
| 207T00000X Neurological Surgery (Licence: CA AFE92388) | |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2021-11-30 |