| NPI | 1508165960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A145787) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 46739) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TX Q9375) | |
| Enumeration Date | 2011-03-23 |
| Last Update Date | 2022-09-25 |