| NPI | 1790125441 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X Radiology, Neuroradiology (Licence: CT 60151) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 5101020509) |
| Enumeration Date | 2013-06-26 |
| Last Update Date | 2018-12-11 |