| NPI | 1811214455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A115116) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: WV 29258) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101258631) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NC N/A) | |
| Enumeration Date | 2010-04-21 |
| Last Update Date | 2021-03-11 |