| NPI | 1053359364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 200400985) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 42043) |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2022-01-25 |