| NPI | 1982815296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X Radiology, Neuroradiology (Licence: WA MD60627720) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD60627720) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 57010492) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TX P8912) | |
| Enumeration Date | 2007-05-25 |
| Last Update Date | 2018-03-05 |