| NPI | 1578967469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME149712) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 7583) |
| Enumeration Date | 2014-10-21 |
| Last Update Date | 2024-01-05 |