| NPI | 1871885400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: AZ 007150) |
| Additional Taxonomies | 2085N0700X Radiology Neuroradiology (Licence: MI 5101019222) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: MI 5101019222) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: AZ 5101007150) | |
| Enumeration Date | 2011-05-16 |
| Last Update Date | 2022-07-21 |