| NPI | 1306878459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: PA MD041777E) |
| Additional Taxonomies | 174400000X Specialist (Licence: PA MD041777E) |
| 2085N0700X Radiology Neuroradiology (Licence: PA MD041777E) | |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2007-11-13 |