| NPI | 1407109770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX P6911) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TX p6911) |
| 261QR0206X Clinic/Center, Radiology, Mammography (Licence: TX p6911) | |
| Enumeration Date | 2012-10-23 |
| Last Update Date | 2019-06-04 |