| NPI | 1043200504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: RI MD11596) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MA 203804) |
| Enumeration Date | 2005-10-26 |
| Last Update Date | 2024-04-17 |