| NPI | 1114902418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO 27242) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: CO 27242) |
| 2085N0700X Radiology, Neuroradiology (Licence: CO 27242) | |
| Enumeration Date | 2005-12-08 |
| Last Update Date | 2013-10-03 |