| NPI | 1265640049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX M7953) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301113497) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TN MD0000040736) | |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2024-04-11 |