| NPI | 1336348549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: LA 205347) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX N0658) |
| Enumeration Date | 2007-07-17 |
| Last Update Date | 2021-11-29 |