| NPI | 1972542173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MT 10514) |
| Additional Taxonomies | 2085N0700X Radiology Neuroradiology (Licence: MT 10514) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: WA MD60705352) | |
| Enumeration Date | 2006-06-05 |
| Last Update Date | 2019-11-13 |