| NPI | 1588735815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX U6450) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO R6H98) |
| Enumeration Date | 2006-11-10 |
| Last Update Date | 2023-11-06 |