| NPI | 1932179041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: KY 55429) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: TX L8258) |
| Enumeration Date | 2006-01-23 |
| Last Update Date | 2021-07-27 |