| NPI | 1366479115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NV 18981) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: UT 7841494-1205) |
| 2085D0003X Radiology, Diagnostic Neuroimaging (Licence: UT 7841494-1205) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NM RS2005-0324) | |
| Enumeration Date | 2006-06-27 |
| Last Update Date | 2019-09-12 |