| NPI | 1700011053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X Radiology Neuroradiology (Licence: PA MD457402) |
| Additional Taxonomies | 2085N0700X Radiology Neuroradiology (Licence: TX R6576) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: TX R6576) | |
| Enumeration Date | 2009-05-15 |
| Last Update Date | 2022-05-05 |