| NPI | 1710367495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 84633) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 5151012607) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 5101021605) | |
| Enumeration Date | 2015-06-08 |
| Last Update Date | 2020-06-23 |