| NPI | 1255674545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME137368) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX R6833) |
| Enumeration Date | 2013-04-04 |
| Last Update Date | 2020-01-31 |