| NPI | 1508125014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2017003571) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX R5131) |
| Enumeration Date | 2012-05-04 |
| Last Update Date | 2018-09-07 |