| NPI | 1912274572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX N8481) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 109246) |
| Enumeration Date | 2011-11-28 |
| Last Update Date | 2024-04-17 |