| NPI | 1831137041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: KY 25444) |
| Additional Taxonomies | 2085N0700X Radiology Neuroradiology (Licence: KY 25444) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: KY 25444) | |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2017-02-14 |