| NPI | 1144547134 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TX T3518)  | 
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX T3518)  | 
| Enumeration Date | 2010-04-29 | 
| Last Update Date | 2024-06-25 |