| NPI | 1700930344 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 63109) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: NC 2012-01543) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2012-01543) | |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2021-07-19 |