| NPI | 1871578252 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: TX L6472) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TX l6472) |
| Enumeration Date | 2005-12-08 |
| Last Update Date | 2019-05-17 |