| NPI | 1275515611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A75941) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: CA A75941) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: VT 042-0011719) | |
| Enumeration Date | 2005-11-18 |
| Last Update Date | 2015-06-09 |