| NPI | 1124514070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 56272) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: DC MTL2000283) |
| Enumeration Date | 2018-07-03 |
| Last Update Date | 2022-05-27 |