| NPI | 1679501522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD483132) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX M4396) |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2023-12-14 |