| NPI | 1477660983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL TPME4570) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX H6472) |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2024-02-12 |