| NPI | 1710913975 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: LA MD.022262) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MS 16495) |
| Enumeration Date | 2006-06-22 |
| Last Update Date | 2021-09-27 |