| NPI | 1124029764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX G5181) |
| Additional Taxonomies | 2085R0203X Radiology, Therapeutic Radiology (Licence: TX G5181) |
| Enumeration Date | 2005-08-04 |
| Last Update Date | 2021-12-06 |