| NPI | 1255772323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: FL ME169291) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MI 4301103084) |
| Enumeration Date | 2013-07-17 |
| Last Update Date | 2024-09-03 |