| NPI | 1972890424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X Radiology, Neuroradiology (Licence: FL ME158538) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT200435) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 283597) | |
| Enumeration Date | 2011-07-06 |
| Last Update Date | 2022-11-14 |