| NPI | 1285809103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX R1077) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 1.050307) |
| Enumeration Date | 2008-04-23 |
| Last Update Date | 2022-01-27 |