| NPI | 1275897902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD61632014) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX R5606) |
| Enumeration Date | 2012-06-27 |
| Last Update Date | 2025-03-04 |