| NPI | 1215223433 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X Radiology, Neuroradiology (Licence: NC 2017-00279) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC LL33854) |
| Enumeration Date | 2011-06-27 |
| Last Update Date | 2017-03-01 |