| NPI | 1518386325 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX S4312) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: TX S4312) |
| Enumeration Date | 2014-04-09 |
| Last Update Date | 2020-10-16 |