| NPI | 1801979109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX N0177) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 24523) |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2021-04-05 |