| NPI | 1679754824 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 24233) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 71411) |
| Enumeration Date | 2007-11-15 |
| Last Update Date | 2025-01-16 |