| NPI | 1770571457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 57339) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX M6426) |
| Enumeration Date | 2005-10-07 |
| Last Update Date | 2022-07-14 |