| NPI | 1619339058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X Radiology Neuroradiology (Licence: GA 92623) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: NC RTL21-0600) |
| Enumeration Date | 2016-03-24 |
| Last Update Date | 2022-07-07 |