| NPI | 1881719334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 23978) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: TX M3217) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: IA 37456) | |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2010-02-01 |