| NPI | 1306108386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX P8914) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MS 28264) |
| Enumeration Date | 2012-06-14 |
| Last Update Date | 2024-06-10 |