| NPI | 1760781066 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X Radiology, Neuroradiology (Licence: NC 2022-02059) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX R2697) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A142322) | |
| Enumeration Date | 2011-03-25 |
| Last Update Date | 2022-09-15 |