| NPI | 1649392028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CA A95760) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: TX M5323) |
| Enumeration Date | 2007-04-04 |
| Last Update Date | 2021-11-12 |