| NPI | 1710203971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X Radiology Neuroradiology (Licence: LA 305178) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: LA 305178) |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: LA 305178) | |
| Enumeration Date | 2010-04-13 |
| Last Update Date | 2024-10-16 |