| NPI | 1578505319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 51344) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MS 10940) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 15098) | |
| 2085N0700X Radiology, Neuroradiology (Licence: KY 51344) | |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2020-05-13 |