| NPI | 1811255896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: LA 310128) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX R0258) |
| Enumeration Date | 2012-04-27 |
| Last Update Date | 2019-07-26 |