| NPI | 1740548734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A114372) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX 44678) |
| Enumeration Date | 2012-04-26 |
| Last Update Date | 2019-02-19 |