| NPI | 1972564250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2024041785) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX J8411) |
| Enumeration Date | 2006-03-28 |
| Last Update Date | 2024-12-12 |