| NPI | 1053774992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2022-00856) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 286715) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101264327) | |
| Enumeration Date | 2016-03-29 |
| Last Update Date | 2022-09-09 |