| NPI | 1770615833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX M5979) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: LA MD.300503) |
| Enumeration Date | 2007-03-12 |
| Last Update Date | 2021-07-15 |