| NPI | 1326343716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX Q6378) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NY P71704) |
| Enumeration Date | 2011-01-17 |
| Last Update Date | 2016-05-02 |