| NPI | 1861678872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 31382) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 054742) |
| Enumeration Date | 2008-01-21 |
| Last Update Date | 2024-01-10 |