| NPI | 1235330754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD60341376) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: WA MD60341376) |
| 2085N0700X Radiology, Neuroradiology (Licence: OR MD165183) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OR MD165183) | |
| Enumeration Date | 2007-05-31 |
| Last Update Date | 2019-05-13 |