| NPI | 1023403938 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MA T291789) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: OR MD202546) |
| Enumeration Date | 2015-03-30 |
| Last Update Date | 2022-06-10 |