| NPI | 1871812065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 65499) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: MN 58856) |
| Enumeration Date | 2010-05-27 |
| Last Update Date | 2020-09-14 |