| NPI | 1124318878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A139432) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX P6515) |
| Enumeration Date | 2011-04-14 |
| Last Update Date | 2016-06-06 |