| NPI | 1639563034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 92009) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35.142675) |
| 2085N0700X Radiology, Neuroradiology (Licence: GA 92009) | |
| Enumeration Date | 2015-03-24 |
| Last Update Date | 2023-01-19 |