| NPI | 1093751224 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OR MD25664) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: VA 0101255768) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WV 25740) | |
| Enumeration Date | 2006-06-22 |
| Last Update Date | 2022-06-10 |