| NPI | 1609165356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CA A128311) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: AR E-14066) |
| 2085N0700X Radiology Neuroradiology (Licence: CA A128311) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: AZ 58381) | |
| Enumeration Date | 2011-04-04 |
| Last Update Date | 2024-05-16 |