| NPI | 1043590540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD60852442) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: WA MD60852442) |
| Enumeration Date | 2011-08-28 |
| Last Update Date | 2021-09-22 |