| NPI | 1811426141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 291846) |
| Additional Taxonomies | 204R00000X Electrodiagnostic Medicine (Licence: MA 272678) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TX BP10062870) | |
| Enumeration Date | 2017-06-09 |
| Last Update Date | 2023-09-18 |