| NPI | 1619995289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: VA 0101236099) |
| Additional Taxonomies | 2085N0700X Radiology Neuroradiology (Licence: VA 0101236099) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: MD D0088083) | |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2020-01-27 |