| NPI | 1073719803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MS 17833) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 135313) |
| Enumeration Date | 2007-06-27 |
| Last Update Date | 2022-10-06 |