| NPI | 1649612763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085N0700X Radiology, Neuroradiology (Licence: CT 62374) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 62374) |
| Enumeration Date | 2013-07-18 |
| Last Update Date | 2019-06-26 |