| NPI | 1821068131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MI 4301038663) |
| Additional Taxonomies | 2085N0700X Radiology Neuroradiology (Licence: MI 4301038663) |
| Enumeration Date | 2006-01-26 |
| Last Update Date | 2014-01-03 |