| NPI | 1053768788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX T7047) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 63205) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TX BP10057664) | |
| Enumeration Date | 2016-05-23 |
| Last Update Date | 2022-08-23 |