| NPI | 1750656104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AL 36156) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 57714) |
| Enumeration Date | 2012-03-19 |
| Last Update Date | 2021-06-09 |