| NPI | 1679710123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: ID M-11892) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX N1961) |
| 2085B0100X Radiology, Body Imaging (Licence: MA 250292) | |
| Enumeration Date | 2009-01-20 |
| Last Update Date | 2019-10-22 |