| NPI | 1922042068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CA A105145) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: CA A105145) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A105145) | |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2019-12-11 |