| NPI | 1891102620 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: ID M-17337) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: ID M-17337) |
| 2085N0700X Radiology, Neuroradiology (Licence: WV 30016) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NV 20293) | |
| Enumeration Date | 2014-07-14 |
| Last Update Date | 2024-04-28 |