| NPI | 1528475050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085N0700X Radiology, Neuroradiology (Licence: MO 2016023603) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: SC 37337) |
| Enumeration Date | 2014-07-16 |
| Last Update Date | 2020-08-21 |