| NPI | 1982693008 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 2085N0700X Radiology Neuroradiology (Licence: IA 19418) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: IA 19418) |
| Enumeration Date | 2005-10-20 |
| Last Update Date | 2007-07-08 |