| NPI | 1841405495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 45621) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 45621020) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301082600) | |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2023-06-13 |