| NPI | 1659448967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX N0277) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: TX N0277) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2023006418) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME138102) | |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2024-04-24 |