| 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 |