| NPI | 1962492033 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X Radiology, Neuroradiology (Licence: MA 59372) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 59372) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 59372) | |
| Enumeration Date | 2005-10-28 |
| Last Update Date | 2012-07-25 |