| NPI | 1992850556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX K0901) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA G82321) |
| Enumeration Date | 2007-01-24 |
| Last Update Date | 2025-03-18 |