| NPI | 1174733075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: AL 26183) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: AL 26183) |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2018-06-27 |