| NPI | 1356344089 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: RI MD04410) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 80777) |
| 2085U0001X Radiology, Diagnostic Ultrasound (Licence: RI MD04410) | |
| Enumeration Date | 2005-05-27 |
| Last Update Date | 2023-08-18 |