| NPI | 1912354515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X Radiology, Neuroradiology (Licence: NC 2021-02001) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 267932) |
| Enumeration Date | 2016-05-24 |
| Last Update Date | 2021-06-15 |