| NPI | 1639184518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X Radiology Neuroradiology (Licence: WA MD00042038) |
| Additional Taxonomies | 2085N0700X Radiology Neuroradiology (Licence: ID M-12982) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: ID M-12982) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: WA MD00042038) | |
| Enumeration Date | 2006-07-29 |
| Last Update Date | 2018-03-08 |