| NPI | 1952725178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MS 27444) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NE 28908) |
| 2085N0700X Radiology, Neuroradiology (Licence: ND 18138) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TX S0343) | |
| Enumeration Date | 2014-02-07 |
| Last Update Date | 2024-05-23 |