| NPI | 1972564094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX L4430) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: TX L4430) |
| 2085D0003X Radiology, Diagnostic Neuroimaging (Licence: TX L4430) | |
| 2085U0001X Radiology, Diagnostic Ultrasound (Licence: TX L4430) | |
| 2085N0700X Radiology, Neuroradiology (Licence: TX L4430) | |
| Enumeration Date | 2006-03-29 |
| Last Update Date | 2015-01-12 |