| NPI | 1316109424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX S8984) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MD D79103) |
| Enumeration Date | 2008-06-30 |
| Last Update Date | 2022-04-09 |