| NPI | 1477823813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX Q3787) |
| Additional Taxonomies | 261QR0207X Clinic/Center, Radiology, Mobile Mammography (Licence: TX Q3787) |
| 261QR0208X Clinic/Center, Radiology, Mobile | |
| Enumeration Date | 2012-01-03 |
| Last Update Date | 2022-08-03 |