| NPI | 1982963914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 89818) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 269842) |
| Enumeration Date | 2012-05-11 |
| Last Update Date | 2021-08-19 |