| NPI | 1295982452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: TX P0123) |
| Additional Taxonomies | 2085N0700X Radiology Neuroradiology (Licence: MA 236442) |
| Enumeration Date | 2008-08-19 |
| Last Update Date | 2018-08-06 |