| NPI | 1811458367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X Radiology, Neuroradiology (Licence: UT 13901864-1205) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ R78153) |
| Enumeration Date | 2019-03-27 |
| Last Update Date | 2024-04-09 |