| NPI | 1679679179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA G58630) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX G3556) |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2024-03-11 |