| NPI | 1427062215 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 293D00000X Physiological Laboratory (Licence: TX R23048) |
| Additional Taxonomies | 335V00000X Portable X-Ray and/or Other Portable Diagnostic Imaging Supplier (Licence: TX R23048) |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2025-09-11 |