| NPI | 1194702852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME155281) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: MD D0075799) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MD D0075799) | |
| Enumeration Date | 2005-12-23 |
| Last Update Date | 2023-03-28 |