| NPI | 1255321329 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 00-24750) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: NC 24750) |
| Enumeration Date | 2005-10-28 |
| Last Update Date | 2014-03-17 |