| NPI | 1801679519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X Radiology, Neuroradiology (Licence: IA SP-0268) |
| Additional Taxonomies | 2085D0003X Radiology, Diagnostic Neuroimaging (Licence: IA SP-0268) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME169514) | |
| Enumeration Date | 2023-08-16 |
| Last Update Date | 2024-09-10 |