| NPI | 1104994847 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X Radiology Neuroradiology (Licence: MI 5101010036) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MI 5101010036) |
| Enumeration Date | 2006-12-01 |
| Last Update Date | 2007-07-08 |