| NPI | 1295092807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 58618) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 69311) |
| Enumeration Date | 2012-04-19 |
| Last Update Date | 2023-08-29 |