| NPI | 1366492761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO 45353) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX K5846) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OK 18927) | |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2014-03-04 |