| NPI | 1588848857 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: LA 201836) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: AZ 45146) |
| Enumeration Date | 2007-12-21 |
| Last Update Date | 2020-06-15 |