| NPI | 1194796292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 29200) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: AZ 29200) |
| 2085D0003X Radiology, Diagnostic Neuroimaging (Licence: AZ 29200) | |
| Enumeration Date | 2006-01-28 |
| Last Update Date | 2013-02-27 |