| NPI | 1588981518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35.133360) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: VA 0101259968) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: GU M-2154) | |
| Enumeration Date | 2010-04-30 |
| Last Update Date | 2019-03-05 |