| NPI | 1568403210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085N0700X Radiology, Neuroradiology (Licence: CA C54527) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: GA 046145) |
| Enumeration Date | 2006-06-10 |
| Last Update Date | 2012-07-06 |