| NPI | 1275594442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: TX Q3674) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: OK 21791) |
| Enumeration Date | 2006-03-29 |
| Last Update Date | 2021-12-08 |