| NPI | 1518167725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CO 52005) |
| Additional Taxonomies | 2085N0700X Radiology Neuroradiology (Licence: AZ 45978) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: AZ 45978) | |
| Enumeration Date | 2007-07-25 |
| Last Update Date | 2015-01-19 |