| NPI | 1871758201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085D0003X Radiology, Diagnostic Neuroimaging (Licence: VT 042-0003147) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: VT 042-0003147) |
| Enumeration Date | 2008-07-24 |
| Last Update Date | 2008-07-24 |