| NPI | 1275739765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO CDRH.0073684) |
| Additional Taxonomies | 2085D0003X Radiology, Diagnostic Neuroimaging (Licence: OR MD157964) |
| Enumeration Date | 2007-06-22 |
| Last Update Date | 2025-03-05 |