| NPI | 1518286640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX R8934) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA OS018303) |
| Enumeration Date | 2010-05-28 |
| Last Update Date | 2022-10-14 |