| NPI | 1851501126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME152510) |
| Additional Taxonomies | 2085D0003X Radiology, Diagnostic Neuroimaging (Licence: GA 65945) |
| 2085N0700X Radiology, Neuroradiology (Licence: FL 105312) | |
| 2085N0700X Radiology, Neuroradiology (Licence: MD 1034480) | |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2022-01-04 |