| NPI | 1396009007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 080957) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX R2510) |
| Enumeration Date | 2012-06-27 |
| Last Update Date | 2019-05-02 |