| NPI | 1285840819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: AR E5806) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: NC 2005-01723) |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2023-11-17 |