| NPI | 1649148750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX 48786) |
| Additional Taxonomies | 2085D0003X Radiology, Diagnostic Neuroimaging (Licence: TX 48786) |
| Enumeration Date | 2025-10-29 |
| Last Update Date | 2025-12-01 |