| NPI | 1023094851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 25393) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX H7511) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: LA MD019382) | |
| Enumeration Date | 2005-12-22 |
| Last Update Date | 2018-07-03 |