| NPI | 1124458542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085D0003X Radiology Diagnostic Neuroimaging (Licence: CA SFP32) |
| Additional Taxonomies | 2085N0700X Radiology Neuroradiology (Licence: CA F5800) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: CA SFP32) | |
| Enumeration Date | 2013-11-21 |
| Last Update Date | 2024-04-08 |