| NPI | 1063541993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: VA 0101245045) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: UT 13516848-1205) |
| Enumeration Date | 2007-03-05 |
| Last Update Date | 2023-10-17 |