| NPI | 1730421918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X Radiology Neuroradiology (Licence: UT 12751734-1204) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: TX S0649) |
| Enumeration Date | 2013-03-26 |
| Last Update Date | 2022-03-18 |