| NPI | 1962688366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085D0003X Radiology Diagnostic Neuroimaging (Licence: FL 137866) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: FL 137866) |
| Enumeration Date | 2008-01-15 |
| Last Update Date | 2020-01-03 |