| NPI | 1548608763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: UT 11745801-1204) |
| Additional Taxonomies | 174400000X Specialist (Licence: NV SL0941) |
| Enumeration Date | 2013-06-10 |
| Last Update Date | 2020-08-05 |