| NPI | 1689036337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085D0003X Radiology, Diagnostic Neuroimaging (Licence: TX V4869) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX 48026) |
| Enumeration Date | 2016-03-22 |
| Last Update Date | 2026-03-24 |