| NPI | 1528358199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: VA 0101263565) |
| Additional Taxonomies | 2085D0003X Radiology Diagnostic Neuroimaging (Licence: NY 287924-1) |
| Enumeration Date | 2011-04-15 |
| Last Update Date | 2020-09-28 |