| NPI | 1144615352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME149286) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 88365) |
| Enumeration Date | 2015-04-03 |
| Last Update Date | 2023-03-28 |