| NPI | 1164819017 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 86169) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: GA 86169) |
| Enumeration Date | 2015-04-17 |
| Last Update Date | 2021-06-28 |