| NPI | 1043291933 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: SC 91412) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: TX L4218) |
| Enumeration Date | 2005-11-08 |
| Last Update Date | 2024-02-07 |