| NPI | 1710545124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085U0001X Radiology, Diagnostic Ultrasound (Licence: NC 2024-01679) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2024-01679) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME147926) | |
| Enumeration Date | 2019-05-31 |
| Last Update Date | 2024-09-13 |