| NPI | 1992772776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NM 2000-46) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX H4948) |
| Enumeration Date | 2006-03-01 |
| Last Update Date | 2013-08-15 |