| NPI | 1700014602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2022-01627) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: NC 2022-01627) |
| 2085N0700X Radiology, Neuroradiology (Licence: PA MD451573) | |
| Enumeration Date | 2009-06-30 |
| Last Update Date | 2024-01-22 |