| NPI | 1891891347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 15486) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: AL 28666) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2016-02125) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TX J8328) | |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2021-03-16 |