| NPI | 1457889560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X Radiology Neuroradiology (Licence: KY 58272) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MA 281688) |
| 2085N0700X Radiology Neuroradiology (Licence: KY TP432) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: KY 58272) | |
| Enumeration Date | 2017-06-02 |
| Last Update Date | 2024-05-13 |