| NPI | 1902864341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME120685) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: AZ 22120) |
| 2085N0700X Radiology, Neuroradiology (Licence: FL ME120685) | |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2023-05-22 |