| NPI | 1992021075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: TX T2955) |
| Additional Taxonomies | 2085D0003X Radiology Diagnostic Neuroimaging (Licence: GA 75871) |
| Enumeration Date | 2010-04-14 |
| Last Update Date | 2022-04-28 |