| NPI | 1154984110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085N0700X Radiology Neuroradiology (Licence: MI 4301505331) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MI 4301505331) |
| Enumeration Date | 2019-04-16 |
| Last Update Date | 2025-08-04 |