| NPI | 1942216445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301064032) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 52290) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2022-11-18 |