| NPI | 1174734446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MI 4301091758) |
| Additional Taxonomies | 2085N0700X Radiology Neuroradiology (Licence: MI 4301091758) |
| Enumeration Date | 2007-05-25 |
| Last Update Date | 2014-11-03 |