| NPI | 1730597758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: ID M-15077) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: UT 9529133-1205) |
| Enumeration Date | 2014-07-23 |
| Last Update Date | 2020-06-04 |