| NPI | 1669852844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A171343) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD61038146) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TX V3566) | |
| Enumeration Date | 2015-06-03 |
| Last Update Date | 2024-09-10 |