| NPI | 1215356233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A161056) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MD D83276) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD472337) | |
| Enumeration Date | 2014-04-08 |
| Last Update Date | 2020-11-30 |