| NPI | 1093918922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: OR DO202377) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: NV DO1398) |
| Enumeration Date | 2007-06-07 |
| Last Update Date | 2021-06-23 |