| 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: MI 1962688366) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL 137866) | |
| Enumeration Date | 2008-01-15 |
| Last Update Date | 2024-11-26 |