| NPI | 1407176712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X Radiology, Neuroradiology (Licence: SC 82819) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME126785) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 82819) | |
| Enumeration Date | 2010-06-09 |
| Last Update Date | 2022-12-07 |