| NPI | 1104036714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X Radiology, Neuroradiology (Licence: NY 292153-1) |
| Additional Taxonomies | 2085D0003X Radiology, Diagnostic Neuroimaging (Licence: MA 231785) |
| 2085N0700X Radiology, Neuroradiology (Licence: MA 231785) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 231785) | |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2020-04-25 |