| NPI | 1073803961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME127540) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 57546) |
| Enumeration Date | 2011-04-12 |
| Last Update Date | 2023-08-08 |