| NPI | 1912117284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX L7209) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: CA A69000) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2024-09-19 |