| NPI | 1104866391 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: UT 178056-1205) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: ID M-10655) |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2021-10-01 |