| NPI | 1851398143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME57390) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA G147136) |
| Enumeration Date | 2005-07-01 |
| Last Update Date | 2022-11-16 |