| NPI | 1972823573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX U1499) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: WA MD60628815) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD60628815) | |
| Enumeration Date | 2010-06-04 |
| Last Update Date | 2023-06-14 |