| NPI | 1902877889 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CA G45283) |
| Additional Taxonomies | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: CA G45283) |
| 2085D0003X Radiology Diagnostic Neuroimaging (Licence: CA G45283) | |
| 2085N0700X Radiology Neuroradiology (Licence: CA G45283) | |
| Enumeration Date | 2006-01-30 |
| Last Update Date | 2012-11-27 |