| NPI | 1497752448 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301501168) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: UT 260525-1205) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: UT 260525-1205) | |
| Enumeration Date | 2005-07-06 |
| Last Update Date | 2020-05-04 |