| NPI | 1922999119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: WV 35112) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: WV 35112) |
| Enumeration Date | 2025-07-14 |
| Last Update Date | 2025-07-14 |