| NPI | 1124243282 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X Radiology Neuroradiology (Licence: MI 5101015698) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MA 222051) |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2011-01-17 |