| NPI | 1710395314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME141405) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A154101) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2014014264) | |
| Enumeration Date | 2014-07-27 |
| Last Update Date | 2024-04-03 |