| NPI | 1902807092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: UT 184451-1205) |
| Additional Taxonomies | 2085N0700X Radiology Neuroradiology (Licence: UT 184451-1205) |
| Enumeration Date | 2005-08-10 |
| Last Update Date | 2010-03-10 |