| NPI | 1669770913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085N0700X Radiology Neuroradiology (Licence: CA A115494) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: PA MT190933) |
| Enumeration Date | 2011-03-10 |
| Last Update Date | 2011-03-10 |