| NPI | 1376987362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: TX R9595) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: TX BP10047320) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: VA 0101263753) | |
| Enumeration Date | 2013-04-22 |
| Last Update Date | 2021-09-30 |