| NPI | 1780950337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: PA MD475665) |
| Additional Taxonomies | 2085N0700X Radiology Neuroradiology (Licence: MD D0081547) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: MD D0081547) | |
| Enumeration Date | 2012-03-28 |
| Last Update Date | 2022-02-16 |