| NPI | 1477710507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101251765) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 220764) |
| Enumeration Date | 2008-05-16 |
| Last Update Date | 2024-09-23 |