| NPI | 1063438752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MI 4301072667) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MD D0062038) |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2022-03-09 |