| NPI | 1467499608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NC 99-01394) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: NC 9901394) |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2023-03-10 |