| NPI | 1972787349 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085D0003X Radiology, Diagnostic Neuroimaging (Licence: CA a73028) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: CA a73028) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA a73028) | |
| Enumeration Date | 2007-12-20 |
| Last Update Date | 2021-12-15 |