| NPI | 1073619623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 17796) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: WI 17796-020) |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2020-02-06 |