| NPI | 1124042197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NC 38723) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: WY 7815A) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2025-06-30 |