| NPI | 1730340191 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AL 43974) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 65464) |
| Enumeration Date | 2008-06-18 |
| Last Update Date | 2023-03-09 |