| NPI | 1871850438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X Radiology, Neuroradiology (Licence: CT 63486) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: NY 295532) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 295532) | |
| Enumeration Date | 2012-04-19 |
| Last Update Date | 2019-06-26 |