NPI | 1164051017 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A201595) |
Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME159477) |
Enumeration Date | 2020-04-03 |
Last Update Date | 2025-07-18 |