| NPI | 1265636211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CO DR.0048259) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: TX M0249) |
| Enumeration Date | 2007-06-13 |
| Last Update Date | 2024-06-24 |