| 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 |