| NPI | 1538373154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301088588) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: MA 246419) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 246419) | |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2021-01-27 |