NPI | 1962762294 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CA 20A14369) |
Additional Taxonomies | 2084A2900X Psychiatry & Neurology, Neurocritical Care (Licence: CA 20A14369) |
2084N0400X Psychiatry & Neurology, Neurology (Licence: CA 20A14369) | |
Enumeration Date | 2012-05-21 |
Last Update Date | 2020-06-02 |