| NPI | 1376603803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X Radiology, Neuroradiology (Licence: FL ME128379) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NC 2011-01233) |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2023-03-01 |