| NPI | 1457391435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X Radiology Neuroradiology (Licence: UT 180295-1205) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: UT 180295-1205) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: ID M-10265) | |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2012-08-29 |