| NPI | 1053805838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 5132) |
| Additional Taxonomies | 2085D0003X Radiology, Diagnostic Neuroimaging (Licence: MI 5101024067) |
| Enumeration Date | 2018-06-15 |
| Last Update Date | 2025-08-21 |