| NPI | 1790887222 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TX L1920) |
| Additional Taxonomies | 2084P0301X Psychiatry & Neurology, Brain Injury Medicine (Licence: TX L1920) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TX L1920) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TX L1920) | |
| Enumeration Date | 2006-09-04 |
| Last Update Date | 2018-04-25 |