| NPI | 1902081128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A114570) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX N8327) |
| Enumeration Date | 2008-01-07 |
| Last Update Date | 2024-04-08 |