| NPI | 1235263401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX M6203) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: LA MD.205111) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2009010046) | |
| Enumeration Date | 2007-03-16 |
| Last Update Date | 2022-09-08 |