| NPI | 1831325372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085N0700X Radiology, Neuroradiology (Licence: NC 2014-00832) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2009013721) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 55686) | |
| Enumeration Date | 2009-06-10 |
| Last Update Date | 2022-07-21 |