| NPI | 1497923361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO 52541) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX N8867) |
| Enumeration Date | 2008-02-13 |
| Last Update Date | 2013-09-13 |