| NPI | 1801259031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OK 39058) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX S9931) |
| Enumeration Date | 2016-04-04 |
| Last Update Date | 2022-07-18 |