| NPI | 1831340926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PR 17841) |
| Additional Taxonomies | 2085N0700X (Licence: PR 17841) |
| 2085N0700X (Licence: FL ME163820) | |
| 2085D0003X Radiology, Diagnostic Neuroimaging (Licence: FL ME163820) | |
| Enumeration Date | 2008-10-07 |
| Last Update Date | 2023-10-11 |