| NPI | 1710285630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX R7893) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: WI 65116-20) |
| Enumeration Date | 2011-03-01 |
| Last Update Date | 2024-04-22 |