| NPI | 1215912423 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X Radiology, Neuroradiology (Licence: MA 70812) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 70812) |
| Enumeration Date | 2005-12-09 |
| Last Update Date | 2007-07-08 |