| NPI | 1376078360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX R8796) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 82128) |
| Enumeration Date | 2017-04-27 |
| Last Update Date | 2023-06-27 |