| NPI | 1205075041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: TX 47974) |
| Additional Taxonomies | 2085B0100X Radiology Body Imaging (Licence: GA N/A) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: MS 766-L) | |
| Enumeration Date | 2009-02-18 |
| Last Update Date | 2023-07-13 |