| NPI | 1962816058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X Radiology, Neuroradiology (Licence: SC 36718) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 36718) |
| 2085D0003X Radiology, Diagnostic Neuroimaging (Licence: SC 36718) | |
| Enumeration Date | 2014-06-17 |
| Last Update Date | 2022-01-05 |