| NPI | 1619131505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X Radiology Neuroradiology (Licence: MO 2014041608) |
| Additional Taxonomies | 208D00000X General Practice (Licence: IN 01068035A) |
| Enumeration Date | 2008-07-10 |
| Last Update Date | 2021-03-18 |