| NPI | 1164868212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX R2753) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: AL 36839) |
| Enumeration Date | 2013-05-16 |
| Last Update Date | 2019-09-03 |