| NPI | 1881915346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: GA 081756) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: VA 0101257809) |
| Enumeration Date | 2010-06-18 |
| Last Update Date | 2023-08-30 |