| NPI | 1720426562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X Radiology Neuroradiology (Licence: PA MD471231) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: PA MD471231) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: MA 273694) | |
| Enumeration Date | 2013-06-13 |
| Last Update Date | 2020-09-08 |