| NPI | 1073501953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: RI 7914) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 53676) |
| Enumeration Date | 2005-10-13 |
| Last Update Date | 2024-04-16 |