| NPI | 1306173091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 50683) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX N5809) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A116175) | |
| Enumeration Date | 2009-11-17 |
| Last Update Date | 2011-12-27 |