| NPI | 1851438311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME106571) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: FL ME106571) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 66258) | |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2020-07-08 |