| NPI | 1760683205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301089742) |
| Additional Taxonomies | 2085D0003X Radiology, Diagnostic Neuroimaging (Licence: MI 4301089742) |
| Enumeration Date | 2007-05-31 |
| Last Update Date | 2019-12-30 |