| NPI | 1619173721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NM RS20070430) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: GU M-2334) |
| Enumeration Date | 2007-06-25 |
| Last Update Date | 2023-02-15 |