| NPI | 1740490903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: TX N1574) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MA 243008) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2012-08-01 |