| NPI | 1023070737 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD60933328) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX K0084) |
| 2085N0700X Radiology, Neuroradiology (Licence: WA MD60933328) | |
| Enumeration Date | 2006-04-06 |
| Last Update Date | 2019-10-10 |