| NPI | 1194967752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: FL ME122600) |
| Additional Taxonomies | 2085N0700X Radiology Neuroradiology (Licence: FL ME122600) |
| Enumeration Date | 2009-03-29 |
| Last Update Date | 2020-09-02 |