| NPI | 1962615971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX 48168) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 70491) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A91223) | |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2024-06-18 |