| NPI | 1225142581 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX P5409) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 045280) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2006-00541) | |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2020-10-02 |