| NPI | 1902162985 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085N0700X Radiology, Neuroradiology (Licence: MN 64683) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301103651) |
| Enumeration Date | 2012-04-04 |
| Last Update Date | 2018-10-15 |