| NPI | 1780047118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MA 277418) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: KY 56119) |
| Enumeration Date | 2016-04-02 |
| Last Update Date | 2022-01-24 |