| NPI | 1669728887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX v3965) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: AL 36307) |
| Enumeration Date | 2012-07-25 |
| Last Update Date | 2024-11-06 |