| NPI | 1366425019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AL 16292) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: AL 16292) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301504919) | |
| Enumeration Date | 2005-11-28 |
| Last Update Date | 2021-08-16 |