| NPI | 1679527097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: LA 15160R) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: LA 15160R) |
| Enumeration Date | 2006-05-20 |
| Last Update Date | 2010-02-25 |