| NPI | 1942250204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X Radiology Neuroradiology (Licence: TX N8231) |
| Additional Taxonomies | 2085N0700X Radiology Neuroradiology (Licence: MD D55507) |
| 2085N0700X Radiology Neuroradiology (Licence: MI 4301087793) | |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2017-01-19 |