| NPI | 1609371590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD61406159) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX U2789) |
| Enumeration Date | 2018-03-24 |
| Last Update Date | 2024-04-25 |