| NPI | 1386080604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX 574838) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: AL 36764) |
| Enumeration Date | 2013-05-14 |
| Last Update Date | 2022-03-31 |