| NPI | 1790104552 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X Radiology, Neuroradiology (Licence: UT 11261638-1205) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: UT 11261638-1205) |
| Enumeration Date | 2014-04-09 |
| Last Update Date | 2021-11-15 |