| NPI | 1629469382 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 81282) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 74252) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL OS17383) | |
| Enumeration Date | 2015-02-16 |
| Last Update Date | 2024-05-07 |