| NPI | 1780653527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: VA 0101247287) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: TX L2948) |
| Enumeration Date | 2006-03-15 |
| Last Update Date | 2010-07-22 |