| NPI | 1205869203 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X Radiology Neuroradiology (Licence: FL ME100031) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: OH 35.083569) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2016-04-11 |