| NPI | 1518301159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301503287) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: TX S1492) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TX S1492) | |
| Enumeration Date | 2013-04-25 |
| Last Update Date | 2020-12-07 |