| NPI | 1063832335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 82641) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 282835) |
| Enumeration Date | 2014-04-24 |
| Last Update Date | 2023-09-05 |