| NPI | 1982633210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: PR 10563) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: NY 198236) |
| 2085N0700X Radiology, Neuroradiology (Licence: PR 10563) | |
| 2085N0700X Radiology, Neuroradiology (Licence: NY 198236) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: PR 10563) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NY 198236) | |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2016-10-04 |