| NPI | 1306853627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: TX K2807) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MO 2019014129) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2021-06-29 |