| NPI | 1033415690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX Q1788) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NH 18218) |
| Enumeration Date | 2011-01-31 |
| Last Update Date | 2025-03-31 |