| NPI | 1144242926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301503560) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: MO 2006004165) |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2021-06-03 |