| NPI | 1831419944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: TX R3945) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: HI 16264) |
| Enumeration Date | 2010-06-11 |
| Last Update Date | 2023-08-09 |