| NPI | 1619461233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MI 4301509471) |
| Additional Taxonomies | 2085D0003X Radiology Diagnostic Neuroimaging (Licence: MI 4351031898) |
| Enumeration Date | 2018-06-18 |
| Last Update Date | 2023-07-12 |