| NPI | 1720277684 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084V0102X Psychiatry & Neurology Vascular Neurology (Licence: KY 44225) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: AZ 81035) |
| 2085D0003X Radiology Diagnostic Neuroimaging (Licence: IA 38132) | |
| 2085N0700X Radiology Neuroradiology (Licence: IA 38132) | |
| 2085N0700X Radiology Neuroradiology (Licence: KY 44225) | |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: IA 38132) | |
| Enumeration Date | 2007-10-17 |
| Last Update Date | 2019-03-14 |