| NPI | 1801108568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085N0700X Radiology, Neuroradiology (Licence: CA 112950) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2024034448) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: ND PT21830) | |
| Enumeration Date | 2010-07-10 |
| Last Update Date | 2025-01-29 |