| NPI | 1861565293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AL 26934) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NM MD2023-1354) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MS 21094) | |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2023-10-12 |