| NPI | 1770559304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NC 2010-01525) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NY 234871) |
| 2085N0700X Radiology, Neuroradiology (Licence: NC 2010-01525) | |
| Enumeration Date | 2006-02-24 |
| Last Update Date | 2015-04-08 |