| NPI | 1326394537 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX 47571) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 61230) |
| Enumeration Date | 2012-07-25 |
| Last Update Date | 2022-04-01 |