| NPI | 1497117865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX T8764) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 271056) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A171952) | |
| Enumeration Date | 2016-03-24 |
| Last Update Date | 2022-08-08 |