| NPI | 1154735561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X Radiology, Neuroradiology (Licence: WA MD61019200) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD61019200) |
| Enumeration Date | 2014-06-13 |
| Last Update Date | 2020-07-01 |