| NPI | 1720075823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MO 2002006504) |
| Additional Taxonomies | 2085N0700X Radiology Neuroradiology (Licence: MO 2002006504) |
| Enumeration Date | 2005-10-04 |
| Last Update Date | 2022-10-19 |