| NPI | 1639130644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: TX R3998) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: OR MD25828) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: WA MD60026889) | |
| Enumeration Date | 2006-03-29 |
| Last Update Date | 2017-10-19 |