| NPI | 1598792988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MO 2014012626) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: TX P0641) |
| 2085N0700X Radiology Neuroradiology (Licence: MO 2014012626) | |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2015-09-28 |