| NPI | 1609806009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NC 200500747) |
| Additional Taxonomies | 2085N0700X Radiology Neuroradiology (Licence: NC 2005-00747) |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2016-09-14 |