| NPI | 1982665550 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX K7910) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX K7910) |
| 207Q00000X Family Medicine (Licence: TX K7910) | |
| Enumeration Date | 2006-03-31 |
| Last Update Date | 2012-09-25 |