| NPI | 1558534891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X Radiology Neuroradiology (Licence: CT 69246) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: NY 252708) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: CT 69246) | |
| Enumeration Date | 2008-04-08 |
| Last Update Date | 2021-08-31 |