NPI | 1902192438 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: FL ME140585) |
Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 269481) |
207T00000X Neurological Surgery (Licence: MI 4301099187) | |
Enumeration Date | 2011-06-23 |
Last Update Date | 2019-06-26 |