| NPI | 1790747202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NC 34179) |
| Additional Taxonomies | 2085N0700X Radiology Neuroradiology (Licence: NC 34179) |
| 2085N0700X Radiology Neuroradiology (Licence: SC 22194) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: SC 22194) | |
| Enumeration Date | 2006-04-03 |
| Last Update Date | 2023-02-03 |