| NPI | 1083679807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CA A73236) |
| Additional Taxonomies | 2085U0001X Radiology Diagnostic Ultrasound (Licence: TX L6125) |
| Enumeration Date | 2006-04-18 |
| Last Update Date | 2021-12-03 |