| NPI | 1134169378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PR 11754) |
| Additional Taxonomies | 174400000X Specialist (Licence: PR 11754) |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2022-03-25 |