| NPI | 1477761369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX M8565) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME88493) |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2023-11-01 |