| NPI | 1982779716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101252336) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX L8102) |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2025-01-24 |