| NPI | 1780658468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL 55001) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: FL ME55001) |
| 2085N0700X Radiology, Neuroradiology (Licence: FL ME55001) | |
| Enumeration Date | 2006-02-17 |
| Last Update Date | 2021-09-16 |