| NPI | 1255494969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA 20A17737) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX L4809) |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2024-04-05 |