| NPI | 1164620035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X Radiology, Neuroradiology (Licence: SC 36794) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 36794) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2007018780) | |
| Enumeration Date | 2007-07-03 |
| Last Update Date | 2020-10-15 |