| NPI | 1699064220 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX T9941) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 27143) |
| Enumeration Date | 2011-04-05 |
| Last Update Date | 2025-04-16 |