| NPI | 1831545953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 5101026139) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: MI 5101026139) |
| Enumeration Date | 2016-05-07 |
| Last Update Date | 2021-12-06 |