| NPI | 1710018304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 040955) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 040955) |
| 207RM1200X Internal Medicine, Magnetic Resonance Imaging (MRI) (Licence: CT 040955) | |
| 2085N0700X Radiology, Neuroradiology (Licence: CT 040955) | |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2010-08-10 |