| NPI | 1063674216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085N0700X Radiology Neuroradiology (Licence: MO 2014015319) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MO 2014015319) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: CO DR.0068937) | |
| Enumeration Date | 2008-06-30 |
| Last Update Date | 2022-11-04 |