| NPI | 1073573093 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA G69394) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX L3024) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: HI 11711) | |
| Enumeration Date | 2006-03-24 |
| Last Update Date | 2017-08-03 |