| NPI | 1811381536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX T2290) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 5101022085) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 4020) | |
| Enumeration Date | 2015-03-19 |
| Last Update Date | 2021-09-15 |