| NPI | 1649353509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X Radiology, Neuroradiology (Licence: AZ 37396) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 25250) |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2015-01-12 |