| NPI | 1376587477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX H0083) |
| Additional Taxonomies | 174400000X Specialist (Licence: TN 14216) |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2016-03-28 |