| NPI | 1477748689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 270006) |
| Additional Taxonomies | 2085D0003X Radiology, Diagnostic Neuroimaging (Licence: TX N6592) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TX N6592) | |
| Enumeration Date | 2007-09-11 |
| Last Update Date | 2013-09-16 |