| NPI | 1477554673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX L6812) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MS 18517) |
| Enumeration Date | 2005-08-10 |
| Last Update Date | 2020-11-17 |