| NPI | 1285839654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CA A81786) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: TX L7931) |
| Enumeration Date | 2007-06-18 |
| Last Update Date | 2014-01-22 |