| NPI | 1912057183 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX N6761) |
| Additional Taxonomies | 2085N0700X (Licence: TX N6761) |
| Enumeration Date | 2007-01-11 |
| Last Update Date | 2016-02-29 |