from the Universidad Central del Este in San Pedro de Macorís, Dominican Republic, and immediately emigrated to the United States to continue postgraduate education in neurology at Saint Louis University In 1986, having completed his neurology residency, he became the founding director of the Saint Louis University stroke center, incorporating a neurovascular ultrasound laboratory dedicated to the application of the new diagnostic technique of Transcranial Doppler.

In 1995, he was recruited by the University of Alabama at Birmingham (UAB) and became the founding director of its Comprehensive Stroke Center,[12] a post that he held until 2003.

[18] He was instrumental in the education and certification of neurologists in diagnostic vascular ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), and angiography.

Following his seminal endovascular work in St. Louis,[7] upon moving to UAB, he continued to collaborate closely with interventional cardiologists and radiologists, becoming a member of the team that largely influenced the application of carotid artery stenting for stroke prevention.

[22][23][24] The 1990s witnessed an interventional turf war between the three major specialties with stakes in the practice of neuroendovascular procedures, namely neurology, neurosurgery and neuroradiology.

His work on mechanical neuroendovascular rescue of acute ischemic stroke[30] preceded the approval by the U.S. Food and Drug Administration (FDA) of devices specifically designed for this purpose,[31] culminating in the widespread acceptance of endovascular thrombectomy as an urgent treatment strategy in these cases.

[6] He promoted the use of hypothermia for the management of critically ill neurologic patients, including stroke,[32] a subject highlighted in a 2001 article and television piece by CNN.