| NPI | 1053494674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX L7452) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO CDR.0005235) |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2025-10-29 |