| NPI | 1629422522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NV 21862) |
| Additional Taxonomies | 2085N0700X Radiology Neuroradiology (Licence: NV 21862) |
| 2085N0700X Radiology Neuroradiology (Licence: CA A171083) | |
| Enumeration Date | 2016-04-17 |
| Last Update Date | 2025-07-30 |