| NPI | 1427077874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: OR MD26107) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: WA MD00045212) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2021-11-24 |