| NPI | 1952537052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME124120) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 74235) |
| Enumeration Date | 2009-06-03 |
| Last Update Date | 2023-03-27 |