| NPI | 1922024306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD00047339) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: GA 051900) |
| 2085N0700X Radiology, Neuroradiology (Licence: ID M-12410) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: ID M-12410) | |
| Enumeration Date | 2006-07-15 |
| Last Update Date | 2017-08-30 |