| NPI | 1811035694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX N4357) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 108365) |
| Enumeration Date | 2007-02-02 |
| Last Update Date | 2021-01-13 |