| NPI | 1952691503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A125830) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX R7761) |
| Enumeration Date | 2011-04-17 |
| Last Update Date | 2018-08-29 |