| NPI | 1831155381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA C55278) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: FL ME87833) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME87833) | |
| Enumeration Date | 2006-04-25 |
| Last Update Date | 2018-08-23 |