| NPI | 1003137084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 52431) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MS 24394) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TX P2434) | |
| Enumeration Date | 2010-06-14 |
| Last Update Date | 2020-11-11 |