| NPI | 1689133720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X Radiology, Neuroradiology (Licence: FL ME167374) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX U5739) |
| Enumeration Date | 2019-03-18 |
| Last Update Date | 2024-05-20 |