| NPI | 1982046769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: OK 5594) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: TX U4426) |
| Enumeration Date | 2013-07-22 |
| Last Update Date | 2023-08-01 |