| NPI | 1538162912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NM MD2013-0288) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX H8241) |
| Enumeration Date | 2005-05-31 |
| Last Update Date | 2013-08-12 |