| NPI | 1740486331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: TX N5464) |
| Additional Taxonomies | 2085N0904X Radiology Nuclear Radiology (Licence: TX N5464) |
| Enumeration Date | 2007-06-21 |
| Last Update Date | 2019-04-15 |