| NPI | 1184129272 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: UT 13816321-1204) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NM DO2023-0585) |
| Enumeration Date | 2018-03-29 |
| Last Update Date | 2024-06-20 |