| NPI | 1235422619 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101259417) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX U8164) |
| Enumeration Date | 2011-05-18 |
| Last Update Date | 2024-10-24 |