| NPI | 1275564718 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PR 013862) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: AL 26773) |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2024-08-19 |