| NPI | 1407143068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301099089) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: MI 4301099089) |
| Enumeration Date | 2011-07-05 |
| Last Update Date | 2022-07-28 |