| NPI | 1861728297 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX P4930) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX 42646) |
| Enumeration Date | 2009-10-20 |
| Last Update Date | 2021-01-20 |