| NPI | 1538142567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 2085N0700X Radiology Neuroradiology (Licence: FL CERTIFICATE #29994) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: FL ME24719) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: MO 118848) | |
| Enumeration Date | 2005-11-23 |
| Last Update Date | 2007-07-09 |