| NPI | 1376533505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2001010884) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NH 25772) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TX K4343) | |
| Enumeration Date | 2005-10-27 |
| Last Update Date | 2024-06-11 |