| NPI | 1013998111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: TX T1936) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: AZ 54280) |
| Enumeration Date | 2005-11-07 |
| Last Update Date | 2023-02-15 |