| NPI | 1184864100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CT 70423) |
| Additional Taxonomies | 2085N0700X Radiology Neuroradiology (Licence: GA 72073) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: GA 72073) | |
| Enumeration Date | 2009-03-03 |
| Last Update Date | 2022-04-24 |