| NPI | 1679953996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X Radiology, Neuroradiology (Licence: WA MD61036738) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301107571) |
| Enumeration Date | 2015-06-02 |
| Last Update Date | 2021-06-28 |