| NPI | 1164698650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: FL ME116136) |
| Additional Taxonomies | 2085N0700X Radiology Neuroradiology (Licence: FL ME116136) |
| Enumeration Date | 2008-05-05 |
| Last Update Date | 2015-03-06 |