| NPI | 1568802452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX R5677) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 006585) |
| 2085N0700X Radiology, Neuroradiology (Licence: TX R5677) | |
| Enumeration Date | 2013-06-25 |
| Last Update Date | 2022-10-21 |