| NPI | 1265875991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MT 70458) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: WA OP60922682) |
| Enumeration Date | 2013-04-11 |
| Last Update Date | 2019-07-15 |