| NPI | 1528402104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX BP20048629) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP10047127) |
| Enumeration Date | 2013-04-25 |
| Last Update Date | 2018-03-17 |