| NPI | 1578751400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX P5397) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A104900) |
| Enumeration Date | 2007-10-04 |
| Last Update Date | 2020-11-18 |