| NPI | 1750519815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME159931) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: AL 34351) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: LA 306950) | |
| Enumeration Date | 2009-06-29 |
| Last Update Date | 2023-03-27 |