| NPI | 1376742379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 89499) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: VA 0101246360) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101246360) | |
| Enumeration Date | 2007-07-11 |
| Last Update Date | 2022-01-24 |