| NPI | 1114982931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA C54386) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX L5287) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 40150) | |
| Enumeration Date | 2006-04-18 |
| Last Update Date | 2013-03-19 |