| NPI | 1194997601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 60568) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: WI 60568-20) |
| Enumeration Date | 2008-03-25 |
| Last Update Date | 2021-01-15 |