| NPI | 1063456713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X Radiology Neuroradiology (Licence: CA A72107) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA A72107) |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2023-03-07 |