| NPI | 1780693424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X Radiology, Neuroradiology (Licence: ND 10285) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: MN 50376) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301078303) | |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2022-04-29 |