| NPI | 1538130612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 28748) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: AZ 28748) |
| 2085D0003X Radiology, Diagnostic Neuroimaging (Licence: AZ 28748) | |
| Enumeration Date | 2006-01-27 |
| Last Update Date | 2013-02-27 |