| NPI | 1316151913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO 58053) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301088704) |
| 2085N0700X Radiology, Neuroradiology (Licence: MA 258700) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 260319) | |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2024-03-29 |