| NPI | 1275103632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085D0003X Radiology, Diagnostic Neuroimaging (Licence: SC 86457) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 12345) |
| Enumeration Date | 2021-06-29 |
| Last Update Date | 2021-06-29 |