| NPI | 1669558367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A74367) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX R9632) |
| Enumeration Date | 2006-10-27 |
| Last Update Date | 2024-09-11 |