| NPI | 1245205715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085D0003X Radiology Diagnostic Neuroimaging (Licence: AZ 52367) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: TX P3457) |
| Enumeration Date | 2006-02-20 |
| Last Update Date | 2025-01-27 |