| NPI | 1396876025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX Q3510) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY R1025) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OK 27712) | |
| Enumeration Date | 2007-03-07 |
| Last Update Date | 2023-07-17 |