| NPI | 1639315286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 59849) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4306892873) |
| 2085N0700X Radiology, Neuroradiology (Licence: TN 51579) | |
| Enumeration Date | 2009-01-05 |
| Last Update Date | 2015-12-02 |