| NPI | 1629265632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX P5431) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MD D72009) |
| Enumeration Date | 2007-10-03 |
| Last Update Date | 2016-09-14 |