| NPI | 1689134314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: WI 83248-20) |
| Additional Taxonomies | 2085N0700X Radiology Neuroradiology (Licence: WI 83428-20) |
| Enumeration Date | 2019-03-20 |
| Last Update Date | 2024-08-22 |