| NPI | 1588610083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 81896) |
| Additional Taxonomies | 2085N0700X (Licence: TX J6474) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TX J6474) | |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2019-03-27 |