| NPI | 1255532883 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 38004) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: VA 0101245424) |
| Enumeration Date | 2007-05-30 |
| Last Update Date | 2022-07-21 |