| NPI | 1700027166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MN 60558) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MA 222334) |
| Enumeration Date | 2009-03-16 |
| Last Update Date | 2021-07-21 |