| NPI | 1750358008 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NV 15601) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 20277) |
| Enumeration Date | 2006-03-07 |
| Last Update Date | 2019-09-27 |