| NPI | 1538366752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MN 64287) |
| Additional Taxonomies | 2085N0700X Radiology Neuroradiology (Licence: MN 64287) |
| 2085N0700X Radiology Neuroradiology (Licence: WI 65598-20) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: WI 65598-20) | |
| Enumeration Date | 2007-06-29 |
| Last Update Date | 2021-07-12 |