| NPI | 1619187903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX M8803) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: TX M8803) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2021-06-10 |