| NPI | 1073555124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: OR MD20980) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: WA MD00036113) |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2022-06-01 |