| NPI | 1285822007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CA A90564) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: TX R9371) |
| Enumeration Date | 2007-10-05 |
| Last Update Date | 2024-09-10 |