| NPI | 1326422528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301504741) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: MI 4301504741) |
| 208D00000X General Practice (Licence: MI 5315070413) | |
| Enumeration Date | 2015-07-17 |
| Last Update Date | 2021-07-02 |