| NPI | 1548606064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X Radiology, Neuroradiology (Licence: DC DO210001713) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: PA OS021366) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0102205397) | |
| Enumeration Date | 2013-05-13 |
| Last Update Date | 2024-05-03 |