| NPI | 1952626079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 93288) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: GU MC-263) |
| 2085N0700X Radiology, Neuroradiology (Licence: DC MD043452) | |
| Enumeration Date | 2010-03-31 |
| Last Update Date | 2024-12-17 |