| NPI | 1790931715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301103078) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: MI 4301103078) |
| 208600000X Surgery (Licence: AZ R70528) | |
| Enumeration Date | 2008-08-10 |
| Last Update Date | 2018-03-17 |