| NPI | 1306296025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2021-00951) |
| Additional Taxonomies | 261QR0206X Clinic/Center, Radiology, Mammography (Licence: KS 05-43247) |
| Enumeration Date | 2016-06-14 |
| Last Update Date | 2022-04-20 |