| NPI | 1144701798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X Radiology Neuroradiology (Licence: MO 2022048354) |
| Additional Taxonomies | 2085P0229X Radiology Pediatric Radiology (Licence: MO 2022048354) |
| Enumeration Date | 2018-08-22 |
| Last Update Date | 2023-01-10 |