| NPI | 1417938598 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX H7644) |
| Additional Taxonomies | 202K00000X (Licence: TX H7644) |
| Enumeration Date | 2005-11-07 |
| Last Update Date | 2025-02-15 |