| NPI | 1811384753 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PR 21323) |
| Additional Taxonomies | 207U00000X Nuclear Medicine (Licence: PR 21323) |
| Enumeration Date | 2015-04-17 |
| Last Update Date | 2022-07-20 |