| NPI | 1184018335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 88404) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX S4104) |
| Enumeration Date | 2015-03-25 |
| Last Update Date | 2022-07-06 |