| NPI | 1538112966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX L1455) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: AR E4290) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: LA MD.12548R) | |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2011-10-18 |