| NPI | 1619215167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 277772) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: NH 18979) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NH 18979) | |
| Enumeration Date | 2013-01-17 |
| Last Update Date | 2023-11-08 |