| NPI | 1386664373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX L3513) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 34721) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WY 14604C) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CO CDR.0001771) | |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2022-11-14 |