| NPI | 1437566965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: RI MD17049) |
| Additional Taxonomies | 2085N0700X (Licence: SC 37331) |
| Enumeration Date | 2014-07-16 |
| Last Update Date | 2022-06-24 |