| NPI | 1679803977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A 98153) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: CA A98153) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 46344) | |
| Enumeration Date | 2010-01-08 |
| Last Update Date | 2024-05-16 |