| NPI | 1033420286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: IA MD-43825) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 57178) |
| 2085N0700X Radiology, Neuroradiology (Licence: WI 57178) | |
| Enumeration Date | 2010-06-22 |
| Last Update Date | 2016-11-15 |