| NPI | 1669645065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: TX Q2215) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: WA MD60475111) |
| Enumeration Date | 2008-04-07 |
| Last Update Date | 2024-04-16 |