| NPI | 1508387663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 72274) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX U1779) |
| Enumeration Date | 2017-06-29 |
| Last Update Date | 2023-08-04 |