| NPI | 1396753794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME111617) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: MI 4301091121) |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2016-04-11 |