| NPI | 1790014496 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX Q6144) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX 42834) |
| Enumeration Date | 2009-12-09 |
| Last Update Date | 2022-03-01 |