| NPI | 1457727497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X Radiology, Neuroradiology (Licence: ZZ 11742) |
| Additional Taxonomies | 2085D0003X Radiology, Diagnostic Neuroimaging (Licence: ZZ 11742) |
| 2085P0229X Radiology, Pediatric Radiology (Licence: ZZ 11742) | |
| Enumeration Date | 2015-08-13 |
| Last Update Date | 2015-08-13 |