| NPI | 1912286949 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: TX Q4596) |
| Additional Taxonomies | 2085D0003X Radiology Diagnostic Neuroimaging (Licence: TX BP10041249) |
| Enumeration Date | 2011-08-09 |
| Last Update Date | 2021-01-21 |