| NPI | 1013258342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A138648) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: AZ TL122) |
| Enumeration Date | 2013-03-12 |
| Last Update Date | 2024-03-21 |