| NPI | 1710097399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AL 27908) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: AL 27908) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 55121) | |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2023-08-09 |