| NPI | 1043591514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME145034) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MD D81150) |
| Enumeration Date | 2011-08-29 |
| Last Update Date | 2020-10-08 |