| NPI | 1003137944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OK 27929) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX Q4075) |
| Enumeration Date | 2010-06-15 |
| Last Update Date | 2022-04-13 |