| NPI | 1750674164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA OP60730003) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NM A-2207-19) |
| Enumeration Date | 2011-05-17 |
| Last Update Date | 2019-02-22 |