| NPI | 1306039425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CA A87176) |
| Additional Taxonomies | 2085N0700X Radiology Neuroradiology (Licence: CA A87176) |
| Enumeration Date | 2007-08-22 |
| Last Update Date | 2012-04-02 |