| NPI | 1417490301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X Radiology Neuroradiology (Licence: ND 19081) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: FL U05266) |
| Enumeration Date | 2016-11-23 |
| Last Update Date | 2023-12-06 |