| NPI | 1104812577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 037921) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: CT 37921) |
| Enumeration Date | 2005-09-21 |
| Last Update Date | 2023-09-07 |