| NPI | 1093815565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085N0700X Radiology Neuroradiology (Licence: MS 20032) |
| Additional Taxonomies | 2085N0700X Radiology Neuroradiology (Licence: FL ME63631) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: FL ME63631) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: MS 20032) | |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2014-04-01 |