| NPI | 1366733404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AR E-11544) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OK 33738) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NM MD2018-0534) | |
| Enumeration Date | 2011-04-24 |
| Last Update Date | 2021-08-05 |