| NPI | 1841310844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: PA MD438798) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MA 229346) |
| Enumeration Date | 2007-03-31 |
| Last Update Date | 2022-07-15 |