| NPI | 1275822413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 46285) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX R4075) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A160712) | |
| Enumeration Date | 2011-03-28 |
| Last Update Date | 2023-11-27 |