| NPI | 1558704908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085N0700X Radiology, Neuroradiology (Licence: WI 77065) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX S7571) |
| 208D00000X General Practice (Licence: VA 0101256568) | |
| Enumeration Date | 2013-04-15 |
| Last Update Date | 2023-09-13 |