| NPI | 1013128057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X (Licence: NH 23493) |
| Additional Taxonomies | 2085N0700X (Licence: CT 045406) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 045406) | |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2023-01-12 |