| NPI | 1336186972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX H4681) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO 40595) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 45230) | |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2016-02-11 |