| NPI | 1962060327 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: ID 2961371) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: CO DR.0064289) |
| Enumeration Date | 2019-05-31 |
| Last Update Date | 2025-01-10 |