| NPI | 1154810745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 72800) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 74020) |
| Enumeration Date | 2018-05-09 |
| Last Update Date | 2024-10-20 |