| NPI | 1114337524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101273320) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT206477) |
| 2085N0700X Radiology, Neuroradiology (Licence: NC 2016-01095) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 65464) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WV 30907) | |
| Enumeration Date | 2014-05-07 |
| Last Update Date | 2022-01-25 |