| NPI | 1811289812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX R3009) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A139799) |
| Enumeration Date | 2011-05-09 |
| Last Update Date | 2022-07-21 |