| NPI | 1568774826 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: UT 10229090-1205) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: MD D0075241) |
| Enumeration Date | 2010-07-02 |
| Last Update Date | 2019-02-26 |