| NPI | 1235178161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085N0700X Radiology, Neuroradiology (Licence: TX M2192) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: TX M2192) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TX M2192) | |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2013-08-06 |