| NPI | 1831168376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085D0003X Radiology, Diagnostic Neuroimaging (Licence: WA MD00047769) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 237827) |
| Enumeration Date | 2006-03-16 |
| Last Update Date | 2021-12-14 |