| NPI | 1356100762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX 162283) |
| Additional Taxonomies | 2085U0001X Radiology, Diagnostic Ultrasound (Licence: TX 8261) |
| Enumeration Date | 2024-03-18 |
| Last Update Date | 2024-03-18 |