| NPI | 1790041861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2019-00699) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: NC 2019-00699) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 269271) | |
| Enumeration Date | 2012-04-03 |
| Last Update Date | 2019-08-20 |