| NPI | 1649222480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA G56010) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: ID M8538) |
| 2085N0700X Radiology, Neuroradiology (Licence: ID M8538) | |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2014-02-05 |