| NPI | 1174723860 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301116067) |
| Additional Taxonomies | 2085D0003X Radiology, Diagnostic Neuroimaging (Licence: IA 38367) |
| 2085N0700X Radiology, Neuroradiology (Licence: MI 4301116067) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: IA R7988) | |
| Enumeration Date | 2007-07-20 |
| Last Update Date | 2018-12-06 |