| NPI | 1073923223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X Radiology Neuroradiology (Licence: MO 2016022726) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MO 2016022726) |
| Enumeration Date | 2014-04-28 |
| Last Update Date | 2019-07-02 |