| NPI | 1104083781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X Radiology, Neuroradiology (Licence: KY 54441) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MD D72705) |
| Enumeration Date | 2008-05-21 |
| Last Update Date | 2022-12-14 |