| NPI | 1194778506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101028853) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 101028853) |
| 2085D0003X Radiology, Diagnostic Neuroimaging (Licence: VA 0101028853) | |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2008-12-02 |