| NPI | 1376535005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NM MD2008-0263) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: TX L3010) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: TX H30713) | |
| Enumeration Date | 2005-08-18 |
| Last Update Date | 2023-10-12 |