| NPI | 1568490605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA G61201) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: CA G61201) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 56124) | |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2021-12-21 |