| NPI | 1023228525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: TX N1419) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: LA 200345) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2012-08-15 |