| NPI | 1629364310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 1986) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 249315) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CO DR.0057220) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 71541) | |
| Enumeration Date | 2011-06-22 |
| Last Update Date | 2024-09-09 |