| NPI | 1235100405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: AZ 17966) |
| Additional Taxonomies | 2085N0700X Radiology Neuroradiology (Licence: AZ 17966) |
| 2085D0003X Radiology Diagnostic Neuroimaging (Licence: AZ 17966) | |
| Enumeration Date | 2006-01-27 |
| Last Update Date | 2015-01-08 |