| NPI | 1376037143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 81118) |
| Additional Taxonomies | 2085D0003X Radiology, Diagnostic Neuroimaging (Licence: WI 81118) |
| Enumeration Date | 2018-06-15 |
| Last Update Date | 2023-07-03 |