| NPI | 1003817230 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: LA MD.07009R) |
| Additional Taxonomies | 2085N0700X Radiology Neuroradiology (Licence: TN 18484) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: TN 18484) | |
| 2085N0700X Radiology Neuroradiology (Licence: VA 0101032902) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: VA 0101032902) | |
| 2085N0700X Radiology Neuroradiology (Licence: LA MD.07009R) | |
| Enumeration Date | 2005-08-10 |
| Last Update Date | 2014-04-24 |