| NPI | 1588077440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 200004026827) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 003619241) |
| Enumeration Date | 2014-06-09 |
| Last Update Date | 2023-07-26 |