| NPI | 1063703791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 262112) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: TX P9867) |
| 2085N0700X Radiology, Neuroradiology (Licence: MA 262112) | |
| Enumeration Date | 2011-04-28 |
| Last Update Date | 2020-04-30 |