| NPI | 1619331360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2022037587) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: MO 2022037587) |
| Enumeration Date | 2016-04-08 |
| Last Update Date | 2022-10-10 |