| NPI | 1487821542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME130513) |
| Additional Taxonomies | 2085D0003X Radiology, Diagnostic Neuroimaging (Licence: OH 57.012939) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2009017513) | |
| Enumeration Date | 2008-05-08 |
| Last Update Date | 2022-07-21 |