| NPI | 1558382366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX S1565) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME563748) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2018-01163) | |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2021-12-20 |