| NPI | 1912091109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX L6803) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 283387) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME127732) | |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2024-02-21 |