| NPI | 1700096435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN MD0000047042) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX N1797) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2014-11-04 |