| NPI | 1013129790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 03355) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0102202829) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 5101015781) | |
| Enumeration Date | 2007-05-04 |
| Last Update Date | 2022-09-22 |