| NPI | 1164733416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX P9547) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX Training) |
| Enumeration Date | 2010-07-01 |
| Last Update Date | 2022-04-16 |