| NPI | 1538505607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WY 11945A) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: AL 36834) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TX 574837) | |
| Enumeration Date | 2013-05-16 |
| Last Update Date | 2019-11-22 |