| NPI | 1891149852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 66666) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: CT 66666) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A174405) | |
| 282N00000X General Acute Care Hospital | |
| Enumeration Date | 2016-04-15 |
| Last Update Date | 2023-10-14 |