| NPI | 1154161222 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MA 1018223) |
| Additional Taxonomies | 2085D0003X Radiology Diagnostic Neuroimaging (Licence: MA 1018223) |
| 2085N0700X Radiology Neuroradiology (Licence: MA 1018223) | |
| Enumeration Date | 2024-05-28 |
| Last Update Date | 2024-08-20 |