| NPI | 1891031670 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME119841) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: FL ME119841) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD466382) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA10489200) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 255616-1) | |
| Enumeration Date | 2012-12-23 |
| Last Update Date | 2019-04-05 |