| NPI | 1013147719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: LA 307179) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: WA MD 60470122) |
| 2085N0700X Radiology, Neuroradiology (Licence: WI 55960) | |
| 207R00000X Internal Medicine (Licence: WA ML60093014) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 55960-20) | |
| Enumeration Date | 2009-07-16 |
| Last Update Date | 2020-08-03 |