| NPI | 1952478745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD60366244) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: WA MD60366244) |
| 2085N0700X Radiology, Neuroradiology (Licence: OR MD27479) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: ID M-12225) | |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2018-05-02 |