| NPI | 1700219375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PR 19892) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX R7859) |
| Enumeration Date | 2013-08-18 |
| Last Update Date | 2021-08-11 |