| NPI | 1164680344 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX P3767) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA 60459039) |
| Enumeration Date | 2008-05-24 |
| Last Update Date | 2014-08-05 |