| NPI | 1508094541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X (Licence: NH 17949) |
| Additional Taxonomies | 2085D0003X Radiology, Diagnostic Neuroimaging (Licence: PA MD454510) |
| 2085N0700X (Licence: PA MD454510) | |
| Enumeration Date | 2009-06-29 |
| Last Update Date | 2017-03-29 |