| NPI | 1083053573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MN 75647) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: NE 31810) |
| Enumeration Date | 2013-06-18 |
| Last Update Date | 2024-03-29 |