| NPI | 1619437779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MD H0100891) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: ND 21575) |
| Enumeration Date | 2019-03-23 |
| Last Update Date | 2024-10-29 |