| NPI | 1396094652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X Radiology Neuroradiology (Licence: TX R4583) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: TX R4583) |
| Enumeration Date | 2012-09-02 |
| Last Update Date | 2018-08-07 |