| NPI | 1235491846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD61315668) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MT MED-PHYS-LIC-126613) |
| Enumeration Date | 2012-06-10 |
| Last Update Date | 2023-05-25 |