| NPI | 1619255775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A141194) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX R8760) |
| Enumeration Date | 2011-07-23 |
| Last Update Date | 2024-09-10 |