| NPI | 1679922603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 88669) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: AL MD.36647) |
| 208D00000X General Practice (Licence: PR 32752-R) | |
| Enumeration Date | 2016-06-09 |
| Last Update Date | 2021-06-24 |