| NPI | 1497191548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085N0700X Radiology, Neuroradiology (Licence: NC 2016-02574) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101270904) |
| Enumeration Date | 2013-05-16 |
| Last Update Date | 2023-04-27 |