| NPI | 1609004407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 65691) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: UT 77713461205) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 29186) | |
| Enumeration Date | 2009-06-30 |
| Last Update Date | 2022-07-26 |