| NPI | 1629737770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX U5901) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX 47488) |
| Enumeration Date | 2021-12-15 |
| Last Update Date | 2025-02-11 |