| NPI | 1235438755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MI 4301099100) |
| Additional Taxonomies | 2085N0700X Radiology Neuroradiology (Licence: MI 4301099100) |
| Enumeration Date | 2011-03-23 |
| Last Update Date | 2021-02-08 |