| NPI | 1720298219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX N9884) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: LA 200896) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2013-06-07 |