| NPI | 1417929779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX P2638) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NV 11819) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 44175) | |
| Enumeration Date | 2006-02-02 |
| Last Update Date | 2020-09-10 |