| NPI | 1629394119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085N0700X Radiology, Neuroradiology (Licence: MI 5101016567) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 54245-021) |
| Enumeration Date | 2010-04-09 |
| Last Update Date | 2013-12-18 |