| NPI | 1992018055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX Q7533) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: MD D74513) |
| Enumeration Date | 2010-07-19 |
| Last Update Date | 2016-06-14 |