| NPI | 1497943500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX R8839) |
| Additional Taxonomies | 2085D0003X Radiology, Diagnostic Neuroimaging (Licence: NC 182126) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD449197) | |
| Enumeration Date | 2007-10-15 |
| Last Update Date | 2018-09-06 |