| NPI | 1750805917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME168399) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX 45825) |
| Enumeration Date | 2017-07-31 |
| Last Update Date | 2024-10-28 |