| NPI | 1811307259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX V5072) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 60872) |
| Enumeration Date | 2014-05-07 |
| Last Update Date | 2025-01-20 |