| NPI | 1669676615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD61029002) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX M0905) |
| Enumeration Date | 2007-06-13 |
| Last Update Date | 2020-08-07 |