| NPI | 1417012360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X Radiology Neuroradiology (Licence: MA 41475) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MA 41475) |
| Enumeration Date | 2006-12-22 |
| Last Update Date | 2008-01-08 |