| NPI | 1992760706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AR E-4453) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX M0111) |
| Enumeration Date | 2006-04-18 |
| Last Update Date | 2018-06-20 |