| NPI | 1669423489 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX M4185) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: AL 30906) |
| Enumeration Date | 2006-05-15 |
| Last Update Date | 2021-08-16 |