| NPI | 1790880599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MD D78778) |
| Additional Taxonomies | 2085N0700X Radiology Neuroradiology (Licence: WI 51367-20) |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2018-03-17 |