| NPI | 1053671636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX U0031) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: MD D79808) |
| Enumeration Date | 2012-05-17 |
| Last Update Date | 2022-12-14 |