| NPI | 1679035646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME166843) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OK 35706) |
| Enumeration Date | 2019-04-01 |
| Last Update Date | 2025-01-09 |