| NPI | 1346483484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 067687) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX N1778) |
| Enumeration Date | 2009-04-17 |
| Last Update Date | 2021-04-08 |