| NPI | 1053517219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO 51074) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NM RS20070313) |
| Enumeration Date | 2007-06-25 |
| Last Update Date | 2021-04-05 |