| NPI | 1396915237 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: VA 0101250928) |
| Additional Taxonomies | 2085N0700X Radiology Neuroradiology (Licence: VA 0101250928) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: MD D0087633) | |
| Enumeration Date | 2008-03-06 |
| Last Update Date | 2020-01-27 |