| NPI | 1184626756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: UT 262683-1205) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: ID M-11640) |
| 2085N0700X Radiology, Neuroradiology (Licence: UT 262683-1205) | |
| Enumeration Date | 2005-08-12 |
| Last Update Date | 2021-09-09 |