| NPI | 1841440021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 253591) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: MA 253591) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: GU EMTL-2022-031) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: GU MC-131) | |
| Enumeration Date | 2008-09-24 |
| Last Update Date | 2023-02-02 |