| NPI | 1578695292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD439630) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 235399) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: DE C7-0002712) | |
| 2085N0700X Radiology, Neuroradiology (Licence: PA MD439630) | |
| Enumeration Date | 2007-03-09 |
| Last Update Date | 2016-06-03 |