| NPI | 1073531042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: TN 41992) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: VA 0101239776) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2021-07-20 |