| NPI | 1275761595 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 59741) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX p9907) |
| Enumeration Date | 2009-06-25 |
| Last Update Date | 2022-11-08 |