| NPI | 1508001603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX U6279) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: AR E-6106) |
| 2085N0700X Radiology, Neuroradiology (Licence: TX U6279) | |
| Enumeration Date | 2008-12-04 |
| Last Update Date | 2023-11-10 |