| NPI | 1477556868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X Radiology, Neuroradiology (Licence: WA MD00040798) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX K4102) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD00040798) | |
| Enumeration Date | 2005-05-31 |
| Last Update Date | 2022-07-21 |