| NPI | 1427310523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: AZ 54143) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NE 6773) |
| 2085N0700X Radiology Neuroradiology (Licence: AZ 54143) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: NE 28782) | |
| Enumeration Date | 2012-06-13 |
| Last Update Date | 2018-03-17 |