| NPI | 1982805255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD448590) |
| Additional Taxonomies | 2085D0003X Radiology, Diagnostic Neuroimaging (Licence: UT 8232714-1205) |
| 2085N0700X Radiology, Neuroradiology (Licence: PA MD448590) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301088547) | |
| Enumeration Date | 2007-05-31 |
| Last Update Date | 2020-08-19 |