| NPI | 1790960144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 136276) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: LA MD204752) |
| Enumeration Date | 2008-01-04 |
| Last Update Date | 2016-04-12 |