| NPI | 1962199786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085B0100X Radiology Body Imaging (Licence: AZ R80210) |
| Additional Taxonomies | 2085N0700X Radiology Neuroradiology (Licence: AZ R80210) |
| Enumeration Date | 2023-04-21 |
| Last Update Date | 2024-06-17 |