| NPI | 1619103462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 0102204116) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: NC 2015-00791) |
| Enumeration Date | 2009-06-08 |
| Last Update Date | 2017-11-16 |