| NPI | 1326020702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX T5970) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: NC 200200402) |
| 2085N0700X Radiology, Neuroradiology (Licence: MD D50202) | |
| Enumeration Date | 2005-11-18 |
| Last Update Date | 2022-08-29 |