| NPI | 1205060951 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2012018920) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: MO 2013025695) |
| Enumeration Date | 2009-05-11 |
| Last Update Date | 2022-07-08 |