| NPI | 1003306754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: ID M-17306) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 69822) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OR MD216181) | |
| Enumeration Date | 2018-05-17 |
| Last Update Date | 2024-05-01 |