| NPI | 1124384474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: WA MD61176199) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: TX R7901) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: ID M-15934) | |
| Enumeration Date | 2012-04-11 |
| Last Update Date | 2021-10-04 |