| NPI | 1053852384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: GA 92316) |
| Additional Taxonomies | 2085B0100X Radiology Body Imaging (Licence: GA 92316) |
| Enumeration Date | 2017-03-20 |
| Last Update Date | 2023-08-08 |