| NPI | 1780826453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: LA DO.000357) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX M0236) |
| Enumeration Date | 2009-03-27 |
| Last Update Date | 2015-11-16 |