| NPI | 1972587798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NC 200200347) |
| Additional Taxonomies | 2085N0700X Radiology Neuroradiology (Licence: NC 200200347) |
| Enumeration Date | 2005-12-05 |
| Last Update Date | 2010-07-15 |