| NPI | 1003831553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD041405L) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: PA MD041405L) |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2015-03-16 |