| NPI | 1275021958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101277999) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX S4878) |
| Enumeration Date | 2018-04-27 |
| Last Update Date | 2023-08-15 |