| NPI | 1306400361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: WA MD61470134) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: LA 338842) |
| Enumeration Date | 2019-04-25 |
| Last Update Date | 2024-07-09 |