| NPI | 1063859288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 65037) |
| Additional Taxonomies | 2085D0003X Radiology, Diagnostic Neuroimaging (Licence: CA A153337) |
| Enumeration Date | 2013-05-29 |
| Last Update Date | 2019-05-23 |