| NPI | 1679884019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301096778) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: MI 4301096778) |
| Enumeration Date | 2010-06-30 |
| Last Update Date | 2017-04-12 |