| NPI | 1316954068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: LA 201142) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX L6171) |
| Enumeration Date | 2006-08-02 |
| Last Update Date | 2015-04-21 |