| NPI | 1831114685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL OS9735) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MD H77682) |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2021-12-16 |