| NPI | 1083174056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X (Licence: UT 13494110-1205) |
| Additional Taxonomies | 2085D0003X Radiology, Diagnostic Neuroimaging (Licence: UT 13494110-1205) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: UT 13494110-1205) | |
| Enumeration Date | 2019-03-25 |
| Last Update Date | 2025-07-24 |