| NPI | 1124550496 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NC 2022-03341) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: UT 10957022-1205) |
| Enumeration Date | 2017-03-28 |
| Last Update Date | 2024-09-25 |