| NPI | 1629073531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: PR 3842) |
| Additional Taxonomies | 2085D0003X Radiology, Diagnostic Neuroimaging (Licence: PR 3842) |
| 261QM1200X Clinic/Center, Magnetic Resonance Imaging (MRI) (Licence: PR 3842) | |
| Enumeration Date | 2005-06-16 |
| Last Update Date | 2024-04-13 |