| NPI | 1083058317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX R0939) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 273836) |
| Enumeration Date | 2013-04-17 |
| Last Update Date | 2020-06-16 |