| NPI | 1861657611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085N0700X (Licence: TX N4517) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TX N4517) | |
| 208D00000X General Practice (Licence: TX N4517) | |
| Enumeration Date | 2008-07-22 |
| Last Update Date | 2016-07-23 |