| NPI | 1245551126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX Q4292) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10037232) |
| 2085P0229X Radiology, Pediatric Radiology (Licence: TX Q4292) | |
| Enumeration Date | 2010-06-15 |
| Last Update Date | 2026-08-06 |