| NPI | 1104183235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 079742) |
| Additional Taxonomies | 2085D0003X Radiology, Diagnostic Neuroimaging (Licence: TN 51016) |
| Enumeration Date | 2012-04-13 |
| Last Update Date | 2023-09-21 |