| NPI | 1861412769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: UT 363889-1205) |
| Additional Taxonomies | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: UT 363889-1205) |
| 2085B0100X Radiology Body Imaging (Licence: UT 363889-1205) | |
| 2085D0003X Radiology Diagnostic Neuroimaging (Licence: UT 363889-1205) | |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2014-01-20 |