| NPI | 1740773563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 101844) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4351031905) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301502914) | |
| Enumeration Date | 2018-06-07 |
| Last Update Date | 2024-09-10 |