| NPI | 1578779450 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: TN 49857) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: TX M9400) |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2016-08-31 |