| NPI | 1770725905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X Radiology, Neuroradiology (Licence: TN MD53896) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: MI 4301094621) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301094621) | |
| Enumeration Date | 2009-04-02 |
| Last Update Date | 2022-03-28 |