| NPI | 1053447268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MS 20161) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL 102012) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: AL 00025773) | |
| Enumeration Date | 2007-02-24 |
| Last Update Date | 2023-08-07 |