| NPI | 1760673958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD60511642) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: WA MD60511642) |
| 2085N0700X Radiology, Neuroradiology (Licence: OR MD188735) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OR MD188735) | |
| Enumeration Date | 2007-08-05 |
| Last Update Date | 2018-09-24 |