| NPI | 1669660866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX FTL 42748) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA FE00048089) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TX FTL 42376) | |
| Enumeration Date | 2007-10-12 |
| Last Update Date | 2016-09-02 |