| NPI | 1619963204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: LA 329261) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MD D0059862) |
| 2085N0700X Radiology, Neuroradiology (Licence: MD D0059862) | |
| Enumeration Date | 2005-09-20 |
| Last Update Date | 2021-12-06 |