| NPI | 1902199185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX R3089) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: PA OT016084) |
| Enumeration Date | 2011-05-23 |
| Last Update Date | 2022-07-21 |