| NPI | 1588665301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: UT 183203-1205) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: ID M-10337) |
| Enumeration Date | 2005-08-02 |
| Last Update Date | 2022-10-11 |