| NPI | 1992858757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085N0700X (Licence: TX N3717) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX N3717) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MS 34818) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: LA 345551) | |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2025-07-02 |