| NPI | 1598085268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301096476) |
| Additional Taxonomies | 2085D0003X Radiology, Diagnostic Neuroimaging (Licence: AZ 50176) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME13571) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 60170) | |
| Enumeration Date | 2010-06-04 |
| Last Update Date | 2022-02-11 |