| NPI | 1215596663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A194947) |
| Additional Taxonomies | 2085N0700X (Licence: CA A194947) |
| 2085D0003X Radiology, Diagnostic Neuroimaging (Licence: CA A194947) | |
| Enumeration Date | 2019-06-10 |
| Last Update Date | 2025-09-11 |