| NPI | 1265415764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX R7789) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA G86155) |
| Enumeration Date | 2005-11-29 |
| Last Update Date | 2020-08-11 |