| NPI | 1740277060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A61802) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX L1819) |
| Enumeration Date | 2005-10-03 |
| Last Update Date | 2019-09-16 |