| NPI | 1689061574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: SC 38214) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: NC 2020-02274) |
| Enumeration Date | 2015-04-19 |
| Last Update Date | 2021-08-02 |