| NPI | 1285045534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: RI MD19815) |
| Additional Taxonomies | 2085D0003X Radiology, Diagnostic Neuroimaging (Licence: WV 27043) |
| 2085N0700X (Licence: MN 66284) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101260494) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 1019007) | |
| Enumeration Date | 2014-05-08 |
| Last Update Date | 2024-03-11 |