| NPI | 1891084869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME115064) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MT212011) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: AL MD43832) | |
| Enumeration Date | 2011-03-30 |
| Last Update Date | 2022-02-25 |