| NPI | 1700092319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: UT 6609646-1205) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: TN 39681) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: ID M-10790) | |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2013-02-07 |