| NPI | 1902030265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX P5798) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: LA 332434) |
| Enumeration Date | 2009-05-14 |
| Last Update Date | 2022-08-10 |