| NPI | 1699705889 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 36754) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: CA A78271) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A78271) | |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2020-09-09 |