| NPI | 1356375695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NV 6698) |
| Additional Taxonomies | 2085N0700X Radiology Neuroradiology (Licence: PA MD441623) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: PA MD441623) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: WA MD00029456) | |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2021-07-08 |