| NPI | 1790752269 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X Radiology, Neuroradiology (Licence: MA 158213) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 158213) |
| Enumeration Date | 2006-03-03 |
| Last Update Date | 2015-08-11 |