| NPI | 1184685299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX L4523) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OK 22746) |
| Enumeration Date | 2006-03-29 |
| Last Update Date | 2023-08-10 |