| NPI | 1164641387 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: UT 12767278-1205) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: CO 45556) |
| Enumeration Date | 2007-04-25 |
| Last Update Date | 2022-06-30 |