| NPI | 1285912485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 053700) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 261426) |
| 2085D0003X Radiology, Diagnostic Neuroimaging (Licence: NY 260888) | |
| Enumeration Date | 2011-07-22 |
| Last Update Date | 2018-03-17 |