| NPI | 1760514574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 67670) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: GA 67670) |
| 2085N0700X Radiology, Neuroradiology (Licence: GA 67670) | |
| Enumeration Date | 2007-03-09 |
| Last Update Date | 2013-04-17 |