| NPI | 1104149715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085N0700X Radiology, Neuroradiology (Licence: AK 101175) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101250253) |
| Enumeration Date | 2010-03-10 |
| Last Update Date | 2023-05-15 |