| NPI | 1972565000 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: TX J6616) |
| Additional Taxonomies | 2085N0700X Radiology Neuroradiology (Licence: TX J6616) |
| 2085N0700X Radiology Neuroradiology (Licence: CA A65698) | |
| Enumeration Date | 2006-04-04 |
| Last Update Date | 2024-06-13 |