| NPI | 1902099443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: TN MD49683) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: TX N8510) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: TN 49683) | |
| Enumeration Date | 2007-08-18 |
| Last Update Date | 2022-07-21 |