| NPI | 1417111501 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301086265) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: MI 4301086265) |
| Enumeration Date | 2008-07-17 |
| Last Update Date | 2012-03-28 |