| NPI | 1750678710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OR PG176936) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: OR PG176936) |
| Enumeration Date | 2011-06-28 |
| Last Update Date | 2016-11-02 |