| NPI | 1295787935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: ID M3383) |
| Additional Taxonomies | 2085N0700X Radiology Neuroradiology (Licence: ID M3383) |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2011-09-24 |