| NPI | 1841210564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX L2105) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL Pending) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2024-11-27 |