| NPI | 1851581540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: MI 4301089243) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: MI 4301089243) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301089243) | |
| Enumeration Date | 2007-07-28 |
| Last Update Date | 2022-02-17 |