| NPI | 1780861864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 88450) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA pending) |
| Enumeration Date | 2008-01-30 |
| Last Update Date | 2021-07-06 |