| NPI | 1801055223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: GU M1758) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 45292) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TX P2279) | |
| Enumeration Date | 2008-06-02 |
| Last Update Date | 2019-11-13 |