| NPI | 1184990574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 56786) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX P8584) |
| Enumeration Date | 2012-03-29 |
| Last Update Date | 2018-05-17 |