| NPI | 1255509840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX T7589) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO 2582) |
| Enumeration Date | 2008-02-15 |
| Last Update Date | 2023-11-16 |