| NPI | 1639112527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX N0559) |
| Additional Taxonomies | 208D00000X General Practice (Licence: TX N0559) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A86918) | |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2024-04-22 |