| NPI | 1548604440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2020040019) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 82958) |
| Enumeration Date | 2013-04-22 |
| Last Update Date | 2021-03-01 |