| NPI | 1548279003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: ND 10303) |
| Additional Taxonomies | 2085N0904X (Licence: TX L6453) |
| 2085N0904X (Licence: ND 10303) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TX L6453) | |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2025-04-28 |