| NPI | 1679796486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X Radiology Neuroradiology (Licence: TN 48192) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: AZ 42942) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: AR E-5928) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: OH 097447) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: TN 48192) | |
| 2085N0700X Radiology Neuroradiology (Licence: OH 097447) | |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2013-09-18 |