| NPI | 1184019986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: ID M-15712) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 72633-20) |
| Enumeration Date | 2015-03-30 |
| Last Update Date | 2021-07-12 |