| NPI | 1215139274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085D0003X Radiology, Diagnostic Neuroimaging (Licence: NC 2022-00219) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: WA MD60281860) |
| 2085N0700X Radiology, Neuroradiology (Licence: MD D71238) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301086401) | |
| Enumeration Date | 2007-06-01 |
| Last Update Date | 2022-04-04 |