| NPI | 1104169432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: TX T8935) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: GA 7385) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: SC 51636) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: FL 134481) | |
| Enumeration Date | 2013-04-04 |
| Last Update Date | 2022-12-06 |