| NPI | 1770665531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX K8751) |
| Additional Taxonomies | 2085N0904X (Licence: TX k8751) |
| Enumeration Date | 2006-10-20 |
| Last Update Date | 2007-08-09 |