| NPI | 1730444894 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X Radiology, Neuroradiology (Licence: MA 265065) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: SC LL35007) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 265065) | |
| Enumeration Date | 2012-07-05 |
| Last Update Date | 2023-03-06 |