| NPI | 1396000469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME142677) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 269529) |
| Enumeration Date | 2012-07-05 |
| Last Update Date | 2023-03-28 |