| NPI | 1477521201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX L4276) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA 49580) |
| Enumeration Date | 2006-03-09 |
| Last Update Date | 2023-09-07 |