| NPI | 1548244312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD059711L) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: PA MD059711L) |
| Enumeration Date | 2005-12-05 |
| Last Update Date | 2016-10-10 |