| NPI | 1386874741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX Q0139) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: TX Q0139) |
| Enumeration Date | 2009-07-20 |
| Last Update Date | 2021-01-07 |