| NPI | 1811039464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101269745) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: VA 0101269745) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD456619) | |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2024-08-29 |