| NPI | 1043449101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX Q1145) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MT194471) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD447976) | |
| Enumeration Date | 2009-07-10 |
| Last Update Date | 2015-05-06 |