NPI | 1053671636 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX U0031) |
Additional Taxonomies | 2085N0700X (Licence: MD D79808) |
2085R0202X Radiology, Diagnostic Radiology (Licence: LA 346608) | |
Enumeration Date | 2012-05-17 |
Last Update Date | 2025-08-19 |